District Hospital Performance Assessment Province 2008-2010

Thokozani Mbatha, Sizulu Moyo, Catherine Ogunmefun, Rene English

District Hospital Performance Assessment

Northern 2008-2010

Thokozani Mbatha, Sizulu Moyo, Catherine Ogunmefun, Rene English

Published by Health Systems Trust

34 Essex Terrace Tel: +27 (0)31 266 9090 Westville Fax: +27 (0)31 266 9199 3630 Email: [email protected] http://www.hst.org.za

Published: November 2011

Suggested citation:

Mbatha T, Moyo S, Ogunmefun C, English R. District Hospital Performance Assessment: Northern Cape Province 2008-1010. Health Systems Trust; Durban, 2012

The information contained in this publication may be freely distributed and reproduced, as long as the source is acknowledged, and it is used for non-commercial purposes.

Acknowledgements

We would like to thank the National Department of Health for providing the data for the report. We are also grateful to Candy Day for assistance with the data. We thank Dr Peter Barron for input and guidance in writing the final report.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 i

Contents

INTRODUCTION ...... 1 BACKGROUND ...... 3 A NAMAKWA DISTRICT – DC6 ...... 5 1. Calvinia (Abraham Esau) Hospital ...... 5 i: Description ...... 5 ii: Input and process indicators ...... 5 iii: Outcomes indicators ...... 7 iv: Impact indicators ...... 7 v: Conclusions: ...... 8 2. Springbok (Dr Van Niekerk) Hospital ...... 9 i: Description ...... 9 ii: Input and process indicators ...... 9 iii: Outcomes indicators ...... 10 iv: Impact indicators ...... 11 v: Conclusions: ...... 12 B PIXLEY KA SEME DISTRICT – DC7 ...... 13 1. (Central Karoo) Hospital ...... 13 i: Description ...... 13 ii: Input and process indicators ...... 13 iii: Outcomes indicators ...... 15 iv: Impact indicators ...... 15 v: Conclusions: ...... 16 2. Douglas (Hester Malan) Hospital ...... 17 i: Description ...... 17 ii: Input and process indicators ...... 17 iii: Outcomes indicators ...... 18 iv: Impact indicators ...... 19 v: Conclusions: ...... 20 3. Manne Dipico (Colesberg) Hospital ...... 21 i: Description ...... 21 ii: Input and process indicators ...... 21 iii: Outcomes indicators ...... 22 iv: Impact indicators ...... 23 v: Conclusions: ...... 24 4. Prieska (Bill Pickard) Hospital ...... 25 i: Description ...... 25 ii: Input and process indicators ...... 25 iii: Outcomes indicators ...... 26 iv: Impact indicators ...... 27 v: Conclusions: ...... 28 C SIYANDA DISTRICT – DC8 ...... 29 1. Gordonia Hospital ...... 29 i: Description ...... 29 ii: Input and process indicators ...... 29 iii: Outcomes indicators ...... 31 iv: Impact indicators ...... 31

District Hospital Performance Assessment: Northern Cape Province 2008-2010 ii

v: Conclusions: ...... 32 2. Hospital ...... 33 i: Description ...... 33 ii: Input and process indicators ...... 33 iii: Outcomes indicators ...... 34 iv: Impact indicators ...... 35 v: Conclusions: ...... 36 3. Hospital ...... 37 i: Description ...... 37 ii: Input and process indicators ...... 37 iii: Outcomes indicators ...... 38 iv: Impact indicators ...... 39 v: Conclusions: ...... 40 4. Hospital ...... 41 i: Description ...... 41 ii: Input and process indicators ...... 41 iii: Outcomes indicators ...... 42 iv: Impact indicators ...... 43 v: Conclusions: ...... 44 D FRANCES BAARD – DC9 ...... 45 1. Hartswater (Connie Vorster) Hospital ...... 45 i: Description ...... 45 ii: Input and process indicators ...... 45 iii: Outcomes indicators ...... 47 iv: Impact indicators ...... 47 v: Conclusions: ...... 48 2. Jan Kempdorp Hospital ...... 49 i: Description ...... 49 ii: Input and process indicators ...... 49 iii: Outcome indicators ...... 50 iv: Impact indicators ...... 51 v: Conclusions ...... 52 3. Barkly West Hospital (No data available) ...... 53 i: Description ...... 53 4. Prof ZK Matthews Hospital ...... 54 i: Description ...... 54 ii: Input and process indicators ...... 54 iii: Outcomes indicators ...... 55 iv: Impact indicators ...... 56 v: Conclusions: ...... 57 5. Warrenton Hospital ...... 58 i: Description ...... 58 ii: Input and process indicators ...... 58 iii: Outcomes indicators ...... 59 iv: Impact indicators ...... 60 v: Conclusions: ...... 61 E JOHN TAOLO GAETSEWE DISTRICT – DC45 ...... 62 1. Kuruman Hospital ...... 62 i: Description ...... 62 ii: Input and process indicators ...... 62

District Hospital Performance Assessment: Northern Cape Province 2008-2010 iii

iii: Outcomes indicators ...... 64 iv: Impact indicators ...... 64 v: Conclusions: ...... 65 2. Tshwaragano Hospital ...... 66 i: Description ...... 66 ii: Input and process indicators ...... 66 iii: Outcome indicators ...... 67 iv: Impact indicators ...... 68 v: Conclusions ...... 69

District Hospital Performance Assessment: Northern Cape Province 2008-2010 iv

Introduction

Health system strengthening is a key objective in both the Negotiated Service Delivery Agreement and the Re-engineered Primary Health Care approach. Effective utilisation of routine data is crucial for improving the effectiveness of service delivery as well as for improvement of health information systems. There remains considerable scope for improved utilisation of routine data for quality improvement.

This report aims to provide health managers at all levels within the health services, with a useful screening tool for assessing District hospital management performance. It provides managers with a snap shot of how a facility is performing in key areas of hospital management. It focuses on individual facilities and assesses seven key hospital performance indicators listed in Table 1. Data on these seven indicators is retrieved primarily from the DHIS. Individual facility data is compared to the national and provincial indicator average values. The hospitals are assessed over a period of three financial years: 2008/2009; 2009/2010 and 2010/2011. These are depicted as 2008, 2009 and 2010 respectively in the graphs and text in the report. The data presented should be viewed with an awareness of problems common to routine data, namely incorrect and missing data, as well as specific contextual factors.

The report should be considered in conjunction with a number of other published documents including; Key District Health Indicators in Primary Health Care- Volume 1,-2007, The Guidebook for District hospital Managers- Health Systems Trust-2006, A District hospital Service Package for South Africa – The South African National Department of Health – 2002, and the Negotiated Service Delivery Agreement.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 1

Table 1: Selected Hospital performance indicators: definitions and description Unit of Indicator Definition Description Numerator Denominator reporting Separations: - How long on The average Discharges + Average length of Inpatients average each length of time Deaths + stay days + 1/2 Day patient spends in inpatients spend in Transfers out + (ALOS) Day patients hospital hospital Day patients

Total Cost per patient The average cost The average cost expenditure Total patient day day equivalent per patient day per patient per day on health per Rand equivalent (CpPDE) seen in a hospital seen in a hospital hospital

The number of patient days during Total patient the reporting days - The proportion of Usable bed period, expressed (Inpatient Total usable bed beds in hospital Percent utilisation rate as a percentage of days + 1/2 days that were utilised (%) (BUR) the sum of the Day patients) or occupied daily number of x 100 useable beds.

The number of The proportion caesarean section Caesarean Caesarean deliveries in which deliveries, All deliveries in section Percent section rate a caesarean expressed as a the facility deliveries (%) (CS rate) section is percentage of all

performed deliveries

Total inpatient separations- The number of all Includes - The proportion of inpatient deaths inpatient Facility crude Total inpatient all inpatient expressed as a transfers out, day Percent death rate deaths separations that percentage of all patients, (%) (FCDR): are deaths inpatient inpatient deaths separations and inpatient discharges.

The number of perinatal deaths per 1000 births. The perinatal Still births and period starts at the The sum of still inpatient early Perinatal Perinatal beginning of foetal births + those Total births in neonatal deaths/ mortality rate viability (28 weeks babies dying within facility deaths in 1000 (PNMR) gestation or 7 days of life per facility births 1000g) and ends 1000 births

at the end of the 7th day after delivery

The number of The number of still babies who are The number The total number Still births/ Still birth rate births per 1000 “born dead” per of still births of births 1000 (SBR): births 1000 births births

District Hospital Performance Assessment: Northern Cape Province 2008-2010 2

Background

The Northern Cape Province is divided into five district municipalities demarcated as shown in Figure 1. In 2010, the province had 17 District Hospitals serving an estimated population of 1 153 286 people. Table 2 gives a list of district Hospitals in the province by district and sub-district location. The number of useable beds per facility is also listed in Table 2.

Figure 1: map of the Northern Cape Province depicting district boundaries (2011)

District Hospital Performance Assessment: Northern Cape Province 2008-2010 3

Table 2: District hospitals in Northern Cape Province: Location by District and local municipality

District Sub-district Hospital name Useable beds Namakwa DC-6 Hantam Calvinia 33 Nama Khoi Springbok 40 Enthanjeni De Aar 51 Pixley ka Seme DC-7 Siyancuma Douglas 34 Umsobomvu Manne Dipico 34 Siyathemba Prieska 30 Gordonia 137 Kai !Garib Siyanda DC-8 Kakamas 30

Keimoes 30 Tsantsabane Postmasburg 30 Phokwane Hartswater 40 J Kempdorp 34 Frances Baard DC-9 Barkly West No data/no information Dikgatlong Prof ZK Matthews 38 Magareng Warrenton 30 John Taolo Gaetsewe (Kgalagadi) DC-45 Kuruman 64 Ga-Segonyana Tshwaragano 143

District Hospital Performance Assessment: Northern Cape Province 2008-2010 4

A Namakwa District – DC6

Namakwa district had an estimated population of 125 035 people in 2010. It has 19 clinics, 9 CHCs, 8 mobile services and 2 district hospitals. There are no regional, provincial tertiary or central hospitals in the district. 1. Calvinia (Abraham Esau) Hospital i: Description

Calvinia (Abraham Esau) district hospital has 33 beds and lies in the Hantam sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS decreased between 2008 and 2008 and was constant thereafter. It was in line with the provincial averages in 2009 and 2010.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 5

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE fluctuated, decreasing between 2008 and 2009 and then increasing in 2010. It was higher than the national and provincial averages throughout this period. The reasons for the fluctuations and the high CpPDE levels should be ascertained.

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR was relatively constant and lower than the national and provincial averages throughout the reporting period. The reasons for the low BUR should be ascertained.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 6 iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

The CS rate increased sharply over the reporting period. It was significantly higher than the national and provincial averages in 2010. The reasons for the sharp increase should be ascertained.

iv: Impact indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths

The FCDR decreased over the reporting period. It was lower than the national and provincial averages in 2009 and 2010.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 7

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR fluctuated, decreasing between 2008 and 2009 and then increasing in 2010. It was higher than the national and provincial averages throughout this period. The reasons for the fluctuations and the high rates should be ascertained.

3. Still birth rate (SBR): number of babies born dead/1000 births

The SBR also fluctuated decreasing between 2008 and 2009 and then increasing slightly in 2010. It was higher than the national and provincial averages throughout the reporting period. The reasons for the fluctuations and the high rates should be ascertained.

v: Conclusions:

The reasons for the high and fluctuating CpPDE, PNMR, and SBR should be ascertained. The sharp increase in the CS rate requires explanation, and the FCDR should be investigated to determine why it is so low.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 8

2. Springbok (Dr Van Niekerk) Hospital i: Description

Springbok (Dr Van Niekerk) district hospital has 40 beds and lies in the Nama Khoi sub- district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS was relatively constant and lower than the national and provincial averages throughout the reporting period. The reasons for the low ALOS need explanation.

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE increased over the reporting period, and was higher than the national and provincial averages in 2010.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 9

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR increased between 2008 and 2010. It was higher than the national and provincial averages throughout this period.

iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

The CS rate was relatively constant between 2008 and 2009, and increased in 2010. It was higher than the national and provincial averages throughout the reporting period. The reasons for the high CS rate should be ascertained.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 10 iv: Impact indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.

The FCDR was relatively constant and lower than the national and provincial averages throughout the reporting period. The FCDR should be investigated for good practices.

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR increased over the reporting period. It was higher than the national and provincial averages in 2009 and 2010. The reasons for the increase should be ascertained.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 11

3. Still birth rate (SBR): number of babies born dead/1000 births

The SBR increased sharply over the reporting period, and was higher than the national and provincial averages in 2010. The reasons for this sharp increase should be ascertained.

v: Conclusions:

The reasons for the high CpPDE, the high CS rate, the high PNMR and SBR should be ascertained. The FCDR should be investigated to determine why it is so low and if any best practices identified these should be shared.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 12

B Pixley ka Seme District – DC7

Pixley ka Seme district had an estimated population of 191 783 people in 2010. It has 10 clinics, 5 CHCs, 12 mobiles services and 4 district hospitals. There are no regional, provincial tertiary or central hospitals in the district. 1. De Aar (Central Karoo) Hospital i: Description

De Aar (Central Karoo) district hospital has 51 beds and lies in the Enthanjeni sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS was relatively constant and lower than the national and provincial averages throughout the reporting period.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 13

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE increased slightly between 2008 and 2010. It was higher than the national and provincial averages throughout this period. The reasons for the high CpPDE should be ascertained.

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR decreased and was lower than the national and provincial averages throughout the reporting period. The reasons for the low BUR should be ascertained.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 14 iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

The CS rate increased by about 33% between 2008 and 2010. It was significantly higher than the national and provincial averages throughout this period. The reasons for these high rates should be ascertained.

iv: Impact indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.

The FCDR fluctuated, decreasing between 2008 and 2009 and then increasing in 2010. It was higher than the national average and lower than the provincial average in 2010.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 15

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR decreased over the reporting period and was in line with the national average in 2010.

3. Still birth rate (SBR): number of babies born dead/1000 births

The SBR increased over the reporting period. It was higher than the national and provincial averages in 2009 and 2010. The reasons for the increase should be ascertained.

v: Conclusions:

The reasons for the high CpPDE, the high CS rate, the high SBR and the low BUR should be ascertained.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 16

2. Douglas (Hester Malan) Hospital i: Description

Douglas (Hester Malan) district hospital has 34 beds and lies in the Siyancuma sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS was relatively constant over the reporting period. It was in line with the provincial averages in 2009 and 2010.

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE decreased over the reporting period reaching a value below R1000 in 2010. It was lower than the national and provincial averages throughout this period. The data should be reviewed to exclude data error and to ascertain the reasons for low CpPDE values.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 17

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR increased sharply between 2008 and 2009, with a further small increase in 2010. It was higher than the national and provincial averages in 2009 and 2010.

iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

Data on the CS rate were not available for the period 2008-2010. This requires urgent investigation.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 18 iv: Impact indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.

The FCDR fluctuated, decreasing sharply between 2008 and 2009 and then increasing in 2010. It was in line with the national average but lower than the provincial average in 2010. The reasons for the sharp decline in 2009 and fluctuations should be ascertained.

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR was extremely high in 2008 and decreased sharply reaching a rate of 30/1000 births in 2010. It was lower than the national and provincial averages in 2010. The data should be reviewed to exclude data error and to ascertain the reasons for the sharp decline in the PNMR.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 19

3. Still birth rate (SBR): number of babies born dead/1000 births

The SBR also decreased sharply between 2008 and 2009 with further smaller decrease in 2010. It was lower than the national and provincial averages in 2010. The data should be reviewed to exclude data error and to ascertain the sharp decline in the SBR.

v: Conclusions:

The CpDE data should be reviewed to exclude data error and to ascertain the reasons for the low values observed. The reasons for the fluctuating FCDR should be ascertained. The absence of the CS rate data requires urgent investigation. If the hospital is unable to perform Caesarean sections then by definition it is no longer a hospital and should be re-classified as a CHC. The PNMR and SBR data should be reviewed to exclude data error and to ascertain the reasons for the sharp decline in rates. The reasons for the low SBR (in 2010) should be investigated for best practices.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 20

3. Manne Dipico (Colesberg) Hospital i: Description

Manne Dipico (Colesberg) district hospital has 34 beds and lies in the Umsobomvu sub- district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS increased over the reporting period and was higher than the national and provincial averages in 2010.

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE decreased over the reporting period and was lower than the national and provincial averages in 2009 and 2010. The reasons for the declining trend in the CpPDE should be ascertained.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 21

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR increased over the reporting period. It was higher than the national and provincial averages in 2009 and 2010.

iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

Data on the CS rate were not available for the period 2008-2010. This requires urgent investigation.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 22 iv: Impact indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.

The FCDR decreased off a high level over the reporting period, and was closer to the national average in 2010. The reasons for the high rates need ascertainment.

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR fluctuated, decreasing between 2008 and 2009 and then increasing in 2010. It was higher than the national and provincial averages throughout this period. The reasons for the fluctuations and the high rates should be ascertained.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 23

3. Still birth rate (SBR): number of babies born dead/1000 births

The SBR also fluctuated decreasing between 2008 and 2009 and then increasing in 2010. It was higher than the national and provincial averages throughout this period. The reasons for the fluctuations and the high rates should be ascertained.

v: Conclusions:

The low and declining CpPDE values should be confirmed the values and the reasons for thereof ascertained. The absence of the CS rate data requires urgent investigation. If the hospital is unable to perform Caesarean sections then by definition it is no longer a hospital and should be re-classified as a CHC. The reasons for the high and fluctuating PNMR and SBR should also be ascertained as should be the reasons for the high FCDR.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 24

4. Prieska (Bill Pickard) Hospital i: Description

Prieska (Bill Pickard) district hospital has 30 beds and lies in the Siyathemba sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS was relatively constant over the reporting period, and was in line with the provincial averages.

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE increased sharply by more than 50% between 2009 and 2010. It was higher than the national and provincial averages throughout this period. The reasons for the high CpPDE should be ascertained.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 25

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR increased slightly between 2008 and 2009 and then decreased sharply in 2010. The reasons for the decline in 2010 require ascertainment.

iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

The CS rate decreased significantly; (by 65%) over the reporting period. It was significantly lower than the national and provincial averages throughout this period. The reasons for the very low and declining rates should be ascertained.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 26 iv: Impact indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.

The FCDR was constant over the reporting period. It was in line with the provincial averages in 2009 and 2010.

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR increased slightly between 2008 and 2009 and then decreased sharply in 2010. It was lower than the national and provincial averages throughout this period. The reasons for the low rates and the sharp decline should be ascertained. The values of the PNMR and the SBR in 2010 are improbably identical which is indicative of data quality problems.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 27

3. Still birth rate (SBR): number of babies born dead/1000 births

The SBR decreased significantly (by 54%) between 2008 and 2010. It was significantly lower than the national and provincial averages throughout this period. The reasons for the sharp decline should be ascertained.

v: Conclusions:

The reasons for the high CpPDE should be ascertained. The sharp decrease in the CS rate, the PNMR and the SBR requires explanation. The identical PNMR and the SBR observed in 2010 should be investigated for data quality problems.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 28

C Siyanda District – DC8

Siyanda district had an estimated population of 244 883 people in 2010. It has 25 clinics, 2 CHCs, 5 mobile services, 4 district hospitals and 1 regional hospital. There are no provincial tertiary or central hospitals in the district 1. Gordonia Hospital i: Description

Gordonia district hospital has 137 beds and lies in the Kai! Garib sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS increased between 2008 and 2009 and was relatively unchanged in 2010. It was higher than the provincial averages throughout the reporting period.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 29

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE increased between 2008 and 2010. It was significantly higher than the national and provincial averages throughout this period. The reasons for this should be ascertained.

3. Usable bed utilisation rate (BUR): measures occupancy of beds that are available for use

The BUR increased between 2008 and 2009 and was largely unchanged in 2010. It was in line with the national and provincial averages in 2010.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 30 iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

The CS rate increased between 2008 and 2009 and was relatively unchanged in 2010. It was significantly higher than the national and provincial averages throughout the reporting period. The reasons for the high CS rate should be ascertained.

iv: Impact indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.

The FCDR was relatively constant over the reporting period. It was higher than the provincial averages throughout this period.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 31

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR increased between 2009 and 2010. It was in in line with the provincial average in 2010. The reasons for the increase in 2010 should be ascertained.

3. Still birth rate (SBR): number of babies born dead/1000 births

The SBR was relatively constant over the reporting period. It was in line with the provincial average in 2010.

v: Conclusions:

The reasons for the high CpPDE, the high CS rate and the increase in the PNMR and SBR should be ascertained.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 32

2. Kakamas Hospital i: Description

Kakamas district hospital has 30 beds and lies in the Kai! Garib sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS decreased between 2008 and 2010. It was higher than the provincial averages throughout this period.

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE was exceptionally low and was significantly lower than the national and provincial averages throughout the reporting period. The data should be reviewed to exclude data error and to ascertain the reasons for these very low values.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 33

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR decreased over the reporting period, reaching a rate of 86.5% in 2010. It was well above the national and provincial averages throughout this period.

iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

Data on the CS rate were not available for the period 2008-2010. This requires urgent investigation.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 34 iv: Impact indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.

The FCDR increased between 2008 and 2009 and was constant in 2010. It was in line with the provincial averages but lower than the national averages throughout the reporting period.

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR decreased sharply (by 71%) between 2008 and 2010. It was significantly lower than the national and provincial averages in 2009 and 2010. The reasons for this sharp decline should be ascertained and the low rate in 2010 investigated.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 35

3. Still birth rate (SBR): number of babies born dead/1000 births

The SBR decreased between 2008 and 2009. It was significantly lower than the national and provincial averages during this period. Data for 2010 were not available. The reasons for the low rates, the decline and the absence of data in 2010 should be ascertained.

v: Conclusions:

The CpPDE data should be reviewed to exclude data error and to ascertain the reasons for the very low values observed. The absence of the CS rate data requires urgent investigation. If the hospital is unable to perform Caesarean sections then by definition it is no longer a hospital and should be re-classified as a CHC. The reasons for the sharp decline in the PNMR should be ascertained. The low PNMR in 2010 should be confirmed and the reasons for this investigated. The low SBR, the sharp decline between 2008 and 2009 and the absence of data in 2010 require urgent investigation.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 36

3. Keimoes Hospital i: Description

Keimoes District hospital has 30 beds and lies in the Kai! Garib sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS was relatively constant over the reporting period. It was in line with the provincial averages.

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE was exceptionally low. It was relatively constant and significantly lower than the national and provincial averages throughout the reporting period. The data should be reviewed to exclude data error and to ascertain the reasons for these very low values.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 37

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR rate increased over the reporting period, and was higher than the national and provincial averages in 2010.

iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

Data on the CS rate were not available for the period 2008-2010. This requires urgent investigation.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 38 iv: Impact indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.

The FCDR fluctuated slightly; increasing between 2008 and 2009 and then decreasing back to the 2008 level in 2010. It was higher than the provincial averages and throughout this period.

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR has decreased significantly (a nearly 3-fold decrease) between 2008 and 2010. It was well below the national and provincial averages in 2009 and 2010. The reasons for this sharp decline should be ascertained.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 39

3. Still birth rate (SBR): number of babies born dead/1000 births

The SBR increased slightly between 2008 and 2009 and then decreased sharply in 2010. It was lower than then national and provincial averages throughout the reporting period. The reasons for the sharp decline should be ascertained.

v: Conclusions:

The CpDE data should be reviewed to exclude data error and to ascertain the reasons for the very low values observed. The absence of the CS rate data requires urgent investigation. If the hospital is unable to perform Caesarean sections then by definition it is no longer a hospital and should be re-classified as a CHC. The reasons for the sharp decline in the PNMR and SBR should be ascertained, and the low rates observed in 2010 should be investigated.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 40

4. Postmasburg Hospital i: Description

Postmasburg district hospital has 30 beds and lies in the Tsantsabane sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS increased between 2008 and 2010. It was higher than the provincial average and lower than the national average in 2010.

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE was relatively constant and was lower than the national and provincial averages throughout the reporting period.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 41

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR was constant in 2008 and 2009 and increased sharply in 2010. It was significantly higher than the national and provincial averages in 2010.

iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

Data on the CS rate were not available for the period 2008-2010. This requires urgent investigation.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 42 iv: Impact indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.

The FCDR increased between 2008 and 2009 and then decreased in 2010. It was in line with the national average. The reasons for the fluctuations should be ascertained.

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR increased sharply over the reporting period, and was closer to the national average in 2010. The reasons for this increase should be ascertained.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 43

3. Still birth rate (SBR): number of babies born dead/1000 births

The SBR increased sharply (a 4-fold increase) between 2008 and 2010. It was in line with the provincial average in 2010. The reasons for this sharp increase should be ascertained.

v: Conclusions:

The reasons for the low CpPDE should be ascertained. The absence of the CS rate data requires urgent investigation. If the hospital is unable to perform Caesarean sections then by definition it is no longer a hospital and should be re-classified as a CHC. The reasons for the sharp increase in the PNMR and the SBR should be ascertained. The fluctuations in the FCDR require explanation.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 44

D Frances Baard – DC9

Frances Baard district had a population of approximately 375 167 people in 2010. It has 34 clinics, 5 CHCs, 5 mobile services and 5 district hospitals. There are no regional, provincial tertiary or central hospitals in the district. 1. Hartswater (Connie Vorster) Hospital i: Description

Hartswater district hospital has 40 beds and lies in the Phokwane sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS increased to 2 days in 2009 and was unchanged in 2010. It was lower than the national and provincial averages throughout this period.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 45

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE decreased significantly (by 65%) between 2008 and 2009, and was largely unchanged in 2010. It was lower than the national and provincial averages in 2009 and 2010. The data should be reviewed to exclude data error and to ascertain the reasons for the very low values in 2009 and 2010.

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR was low and increased by 25% over the reporting period. It was lower than the national and provincial averages throughout this period. The reasons for the low BUR should be ascertained

District Hospital Performance Assessment: Northern Cape Province 2008-2010 46 iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

The CS rate increased sharply (by 65%), over the reporting period. It was higher than the national and provincial averages in 2010. The reasons for this increase should be ascertained.

iv: Impact indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.

The FCDR was relatively constant over the reporting period. It was lower than the national and provincial averages in 2009 and 2010.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 47

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR was very low in 2008, and there were no data for 2009 and 2010. The very low rate in 2008 should be confirmed and the reasons for the absence of data in 2009 and 2010 should be ascertained.

3. Still birth rate (SBR): number of babies born dead/1000 births

The SBR was also was very low in 2008 and there were no data for 2009 and 2010. . The very low rate in 2008 should be confirmed and the reasons for the absence of data in 2009 and 2010 should be ascertained.

v: Conclusions:

The CpPDE data should be reviewed to exclude data error and to ascertain the reasons for the very low values in 2009 and 2010. The sharp increase in the CS rate requires explanation. The very low PNMR and SBR in 2008 should be confirmed and the absence of data in 2009 and 2010 requires urgent investigation. The low BUR needs explanation.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 48

2. Jan Kempdorp Hospital i: Description

Jan Kempdorp district hospital has 34 beds and lies in the Phokwane sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS fluctuated, decreasing between 2008 and 2009 and then increasing in 2010. It was higher than the provincial average in 2010. The reasons for the fluctuations should be ascertained.

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE was exceptionally low and increased to R494 in 2010. It was significantly lower than the national and provincial averages throughout the reporting period. The data should be reviewed to exclude data error and to ascertain the reasons for these very low values.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 49

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR fluctuated, decreasing between 2008 and 2009 and then increasing in 2010. It was much lower than the national and provincial averages throughout this period. The reasons for the fluctuations and the low rates should be ascertained.

iii: Outcome indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

Data on the CS rate were not available for the period 2008-2010. This requires urgent investigation.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 50 iv: Impact indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.

The FCDR increased over the reporting period. It was in line with the provincial averages and lower than the national averages throughout the reporting period.

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR increased significantly (more than doubled) between 2008 and 2010. It was lower than the national and provincial averages throughout this period. The reasons for the increase should be ascertained.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 51

3. Still birth rate (SBR): number of babies born dead/1000 births

The SBR also increased significantly (2.5 times) over the reporting period. It was lower than the national and provincial and averages throughout this period. The reasons for the increase should be ascertained.

v: Conclusions

The ALOS data should be reviewed to ascertain the reasons for the fluctuations observed. The CpPDE data should be reviewed to exclude data error and to ascertain the reasons for the very low values. The BUR data should also be reviewed to ascertain the reasons for the fluctuations and the low rates observed. The absence of the CS rate data requires urgent investigation. If the hospital is unable to perform Caesarean sections then by definition it is no longer a hospital and should be re-classified as a CHC. The reasons for the sharp increase in the PNMR and SBR should also be ascertained.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 52

3. Barkly West Hospital (No data available) i: Description

Barkly West district hospital lies in the Dikgatlong sub-district.

Data for all indicators were not available for the period 2008-2010. This should be investigated.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 53

4. Prof ZK Matthews Hospital i: Description

Prof ZK Matthews district hospital has 38 beds and lies in the Dikgatlong sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS was constant in 2008 and 2009 and decreased to 0.7 days in 2010. It was lower than the national and provincial averages throughout this period. The reasons for these low values should be ascertained.

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE decreased sharply over the reporting period, reaching a very low level of R358 in 2010. It was lower than the national and provincial averages in 2009 and 2010. The data should be reviewed to exclude data error and to ascertain the reasons for the low values in 2009 and 2010.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 54

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR decreased between 2008 and 2009 and then increased sharply, reaching 55.7% in 2010, when it then closer to national and provincial averages. It was lower than the national and provincial averages throughout this period. The reasons for the low BUR should be ascertained.

iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

Data on the CS rate were not available for the period 2008-2010. This requires urgent investigation.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 55 iv: Impact indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.

The FCDR was constant in 2008 and 2009 and decreased to 1% in 2010. It was lower than the national and provincial averages throughout this period. The data should be reviewed to exclude data error and to ascertain the reasons for the very low rate in 2010.

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR fluctuated sharply, decreasing between 2008 and 2009 and then increasing in 2010 when it was then in line with the national average. The reasons for the fluctuations should be ascertained

District Hospital Performance Assessment: Northern Cape Province 2008-2010 56

3. Still birth rate (SBR): number of babies born dead/1000 births

The SBR also fluctuated sharply, decreasing between 2008 and 2009 and then increasing in 2010. It was in line with the provincial average in 2010. The reasons for the fluctuations should be ascertained.

v: Conclusions:

Overall this appears to be a hospital that is functioning sub-optimally. The ALOS and CpPDE data should be reviewed to exclude data error and to ascertain the reasons for the values observed. The low BUR also requires investigation. The absence of the CS rate data requires urgent investigation. If the hospital is unable to perform Caesarean sections then by definition it is no longer a hospital and should be re-classified as a CHC. The low FCDR should also be investigated to determine why it is so low. The PNMR and the SBR data should be reviewed to ascertain the reasons for the fluctuations observed and the increase in values in 2010.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 57

5. Warrenton Hospital i: Description

Warrenton district hospital has 30 beds and lies in the Magareng sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS decreased over the reporting period reaching a level of 1.2 days in 2010. It was lower than the national and provincial averages in 2009 and 2010.

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE decreased sharply between 2008 and 2010. It was significantly lower than the national and provincial averages in 2009 and in 2010. The data should be reviewed to exclude data error and to ascertain the reasons for the very low values in 2009 and 2010.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 58

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR decreased over the reporting period reaching a very low rate of 28% in 2010. It was significantly lower than the national and provincial averages throughout the reporting period. The reasons for the low BUR should be ascertained.

iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

Data on the CS rate were not available for the period 2008-2010. This requires urgent investigation.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 59 iv: Impact indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.

The FCDR increased over the reporting period. It was higher than the provincial average in 2010.

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

There were no PNMR data for 2009. The 2008 and 2010 rates were significantly lower than the national and provincial averages. The data should be reviewed to confirm the 2008 and 2010 rates and to ascertain the reasons for absence of data in 2009.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 60

3. Still birth rate (SBR): number of babies born dead/1000 births

SBR data were not available for 2009 and 2010. In 2008, the SBR was very low, about 4 times lower than the national and provincial averages in the same year. The reasons for the absence of data in 2009 and in 2010 and the low rate in 2008 should be ascertained.

v: Conclusions:

This appears to be a hospital that is functioning sub-optimally. The very low ALOS value in 2010 should be confirmed. The CpPDE data should be reviewed to exclude data error and to ascertain the reasons for the very low values in 2009 and 2010. The reasons for the very low BUR should be ascertained. The absence of the CS rate data requires urgent investigation. If the hospital is unable to perform Caesarean sections then by definition it is no longer a hospital and should be re-classified as a CHC. The PNMR and SBR data should be reviewed to confirm the rates recorded and to ascertain the reasons for the absence of data at some time points during the reporting period.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 61

E John Taolo Gaetsewe District – DC45

John Taolo Gaetsewe district had an estimated population of 216 419 people in 2010. It has 24 clinics, 10 CHCs, 5 mobile services and 2 district hospitals. There are no regional, provincial tertiary or central hospitals in the district 1. Kuruman Hospital i: Description

Kuruman district hospital has 64 beds and lies in the Ga-Segonyama sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS increased over the reporting period. It was in line with the provincial average in 2010.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 62

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE increased sharply (a 4.5 fold increase) between 2008 and 2010. It was significantly higher (more than a 100% greater) than the national and provincial averages in 2010. The reasons for this sharp increase should be ascertained.

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR decreased sharply from a very high level (over 100%) in 2008 to 39% in 2010. The data should be reviewed to exclude data error and to ascertain the reasons for the sharp decline observed.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 63 iii: Outcomes indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

The CS rate was relatively constant over the reporting period. It was in line with the provincial averages in 2009 and 2010.

iv: Impact indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.

The FCDR increased sharply between 2009 and 2010. The 2010 rate was higher than the provincial average. The reasons for this sharp increase should be ascertained.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 64

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR decreased between 2008 and 2009 and then increased sharply in 2010, doubling and reaching a level well above the national and provincial averages. The reasons for the sharp increased should be ascertained.

3. Still birth rate (SBR): number of babies born dead/1000 births

The SBR increased sharply over the reporting period and was significantly higher than the national and provincial averages in 2010. The reasons for this increase should be ascertained.

v: Conclusions:

The ALOS data should be reviewed to exclude data error. The reasons for the sharp increase in the CpPDE, the FCDR, the PNMR and the SBR should be ascertained. The BUR data should be reviewed to exclude data error and to ascertain the reasons for the sharp decline observed.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 65

2. Tshwaragano Hospital i: Description

Tshwaragano district hospital has 143 beds and lies in the Ga-Segonyama sub-district. ii: Input and process indicators

1. Average length of stay (ALOS) – the average length of time inpatients spend in hospital

The ALOS decreased between 2008 and2009 and was relatively constant in 2010. It was in line with the national averages in 2009 and 2010.

2. Cost per patient day equivalent (CpPDE): measure of efficiency in the hospital

The CpPDE fluctuated, increasing between 2008 and 2009 and then decreasing in 2010. It was generally in line with the national and provincial averages in 2010.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 66

3. Usable bed utilisation rate (BUR): measures occupancy of beds which are available for use

The BUR decreased slightly between 2008 and 2009 and then increased in2010. It was in line with the national and provincial averages in 2010.

iii: Outcome indicators

Caesarean section (CS) rate: proportion of deliveries for which a CS is performed

The CS rate was relatively constant over the reporting period. It was significantly lower than the national and provincial averages throughout the reporting period.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 67 iv: Impact indicators

1. Facility crude death rate (FCDR): proportion of all inpatient separations that are deaths.

The FCDR was relatively constant and higher than the national and provincial averages throughout the reporting period.

2. Perinatal mortality rate (PNMR) – the sum of still births + those babies dying within 7 days of life/1000 births

The PNMR fluctuated sharply, decreasing between 2008 and 2009 and then increasing in 2010. It was in line with the national average in 2010. The data should be reviewed to ascertain the reasons for the fluctuations observed.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 68

3. Still birth rate (SBR): number of still births/1000 births

There were no SBR data in 2009. It was relatively constant in 2008 and in 2010. It was in line with the national average in 2010. The absence of data in 2009 requires investigation.

v: Conclusions

The reasons for the high FCDR should be ascertained. The PNMR data should be reviewed to ascertain the reasons for the fluctuations observed and the absence of SBR data in 2009 requires investigation. The reasons for the low C Section rates need to be ascertained.

District Hospital Performance Assessment: Northern Cape Province 2008-2010 69